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BIOSCRIP INFUSION SERVICES, LLC
DSH510029 Thomas Memorial Hospital
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Covered Entity Details
Entity Name
Thomas Memorial Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510029
Entity Address
4605 MacCorkle Avenue, SW
South Charleston, WV 25309
Medicare Provider Number
510029
Participating Start Date
7/1/2014
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
BIOSCRIP INFUSION SERVICES, LLC
Pharmacy Address
DBA BIOSCRIP INFUSION SERVICES
2600 MIDDLETOWN COMMONS STE 131
WHITE HALL, WV 26554-2859
Pharmacy Comments
Contract Details
Approval Date
7/14/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/7/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dan Lauffer, Chief Operating Officer
(304) 766-3595
Contract Pharmacy Representative
BioScrip
Tanya Sutton, General Manager
(304) 534-7080
Signed By Date
7/14/2015
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